decisionhealth Newsletters, Part B News - 2017 Issue 1 (January)
Lab tests without proper documentation, undercoded E/M cause improper payments
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Article Overview
This article summarizes CMS improper payment findings for Medicare Part B services and explains why certain frequently billed categories drew attention in the 2016 report. It is relevant to coders, billing staff, compliance teams, and clinicians who want to understand the broad documentation and coding issues highlighted in the annual error-rate data, especially for laboratory services and evaluation and management services.
Why This Topic Matters
The article helps readers understand which high-volume service categories were associated with improper payments and why documentation and coding accuracy can materially affect Medicare claims performance and audit risk. It also points to the importance of aligning orders, records, and code selection with payer expectations.
What You Will Learn
- How CMS and CERT data are used to identify high-improper-payment Medicare Part B services.
- Why documentation shortfalls and coding errors can affect payment accuracy.
- Which broad service categories were highlighted in the 2016 improper payment discussion.
- Why evaluation and management coding patterns remain a recurring compliance concern.
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Physicians and other clinicians
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
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